ESD and beyond – The benefits of “getting it early” Dr Philip Hall Consultant Gastroenterologist Belfast City Hospital

Overview Endoscopic resection of early cancers Where we are currently Benefits of getting it early Where we are currently How do you we get it early Future

What is early?

Endoscopic resection (EMR)

European Society of Gastrointestinal Endoscopy 2015 EMR is an acceptable option for lesions smaller than 10–15mm with a very low probability of advanced histology. However, ESGE recommends ESD as treatment of choice for most gastric superficial neoplastic lesions (strong recommendation, moderate quality evidence).

Endoscopic Submucosal Dissection

Endoscopic Submucosal Dissection Benefits Problems Remove tumour in one piece Definitive cure endoscopically Avoid unnecessary operations Curative treatment for those not fit for surgery Equipment Technically challenging Longer procedures General anaesthesia

Equipment

Training

Training

Challenges New services General anaesthesia Nursing Aiming to start (very) soon

How do you get it early Symptoms Awareness Good services/pathways Is this early enough?

Getting it early Quantity of screening Quality of screening Training, technology, ?AI Smart screening Focus on high risk groups New methods…….

Cytosponge Breath testing

Now recruiting in Belfast Saliva/blood test

HALO Registry Based in UC London Combining data across the UK to drive improvement EMR database

Summary ESD is coming – minimally invasive curative cancer resection Getting a diagnosis early - important as ever in making the best use of this Focus on pre-cancer and high risk groups Non invasive screening and technology may hold the answer.